Regulating whole exome sequencing as a diagnostic test

In the last decade, there has been a flood of new technology in the sequencing arena. The onset of next-generation sequencing (NGS) technology has resulted in the vast increase in genetic diagnostic testing available to the ordering physician. Whole exome sequencing (WES) has become available as a diagnostic test performed in certified clinical laboratories. This has led to increased presence in the diagnostic marketplace, increased consumer awareness, and the question has been raised by various stakeholders to whether there is sufficient stringent regulation of WES and other NGS-based tests. We discuss the various WES services currently available in the marketplace, current regulation of WES as a laboratory developed test, the proposed FDA involvement in its oversight as well as the response of various laboratory groups that provide these diagnostic services. Overall, a rigorous process oversight and assessment of inter-lab reproducibility is strongly warranted for WES as it is used as a diagnostic test, but regulation should be mindful of the excessive administrative burden on academic and smaller diagnostic laboratories.     

Observations on paraffin baiting as a laboratory diagnostic procedure in nocardiosis

The efficacy of paraffin bait technique in the isolation ofNocardia asteroides from clinical specimens has been investigated. In a comparative study 1091 clinical specimens, mostly sputa and bronchial aspirates collected from 639 patients of bronchopulmonary diseases and 11 of meningitis, were examined by paraffin baiting and the conventional technique. Thirty-six clinical specimens originating from 12 of the patients yieldedN. asteroides by the paraffin bait technique but only 4 by the conventional technique. Approximately 95 % of 125 sputum samples inoculated withN. asteroides yielded the pathogen by paraffin baiting as against 49 % by the conventional technique. Paraffin baiting was more productive than the conventional technique in the isolation ofN. asteroides from mixed suspensions with a number of fungi and bacteria. It is concluded that paraffin baiting can be profitably adopted as a suitable technique for the isolation ofN. asteroides from clinical specimens, such as, sputum, gastric lavage, etc., which are often contaminated. The technique has no particular advantage with non-contaminated specimens.This work forms a part of the Ph. D. thesis of S.K.M. submitted in 1971 to the University of Delhi, and was presented at the Vth meeting of ISHAM held in Paris from 5th–10th July, 1971.     

Efficacy and pattern of use of sputum cytology as a diagnostic test

Sputum cytology is regarded by many clinicians as a noninvasive, cheap and simple test for the diagnosis of bronchogenic carcinoma. Since the introduction of fibre-optic bronchoscopy and more easily obtained bronchial biopsies reliance on sputum cytology has diminished. However, in Edinburgh it was perceived that sputum samples were still being sent as well as, rather than instead of, bronchoscopic specimens. This retrospective study was undertaken to determine whether or not cytological examination of sputum is an efficient and sensitive test in the investigation of patients with suspected bronchogenic carcinoma. It demonstrated that the Lothian University Hospitals NHS Trust Pathology Directorate receives many sputa from departments not specializing in respiratory disease when there is no indication for the test. In addition, we have shown that the absolute sensitivity of the test is only 5% and that when there is a strong clinical suspicion of bronchogenic carcinoma the results of sputum cytology do not play a significant role in the management of the patient. We recommend that sputum cytology is restricted to those patients under the care of Respiratory Units in whom bronchoscopy is inappropriate or unsuccessful.     

A statistical method for the comparison of a discrete diagnostic test with several continuous diagnostic tests.

In this paper we study a statistic that is suitable for comparing a discrete diagnostic marker to one or more continuous diagnostic markers. Test procedures and confidence intervals are based on asymptotic normality. The statistic is applicable for correlated data in which all the markers are obtained for each subject. The statistic was studied for use in comparing two markers for rectal bleeding. Examples for this application and two more general applications are presented.     

Identification of fusobacteria in a routine diagnostic laboratory

A scheme for differentiating Fusobacterium spp. and Leptotrichia spp. from Bacteroides spp. was devised after examining 114 strains of fusobacteria and asaccharolytic bacteroides (17 reference strains and 97 clinical isolates). Sensitivity to a 300 micrograms/ml plate of phosphomycin and an acid reaction on a lysine plate were found to be reliable for differentiating Fusobacterium spp. and L. buccalis from Bacteroides. Using a short set of simple cultural and biochemical tests, isolates could be identified as F. necrophorum, F. necrogenes, F. nucleatum, F. varium or L. buccalis. These tests were: indole, lecithinase, phosphatase, DNase and gas production, aesculin and casein hydrolysis, greening of casein/methylene blue agar, nitrite reduction, bile tolerance and haemolysis on horse blood agar.     

Identification of fusobacteria in a routine diagnostic laboratory

A scheme for differentiating Fusobacterium spp. and Leptotrichia spp. from Bac-teroides spp, was devised after examining 114 strains of fusobacteria and asac-charolytic bacteroides (17 reference strains and 97 clinical isolates). Sensitivity to a 300 μg/ml plate of phosphomycin and an acid reaction on a lysine plate were found to be reliable for differentiating Fusobacterium spp. and L. buccalis from Bacteroides Using a short set of simple cultural and biochemical tests, isolates could be identified as F. necrophorum, F. necrogenes, F. nucleatum, F. varium or L. buccalis . These tests were: indole, lecithinase, phosphatase, DNase and gas production, aesculin and casein hydrolysis, greening of casein/methylene blue agar, nitrite reduction, bile tolerance and haemolysis on horse blood agar.     

The use of CA-IX as a diagnostic method for oral leukoplakia

Abstract

The presence and degree of dysplasia are important diagnostic and prognostic criteria for oral leukoplakia, but evaluation of dysplasia is difficult and subjective. Carbonic anhydrase-IX (CA-IX) is expressed primarily in tumor cells and is considered a specific hypoxia marker. We investigated the role of CA-IX in oral leukoplakia. We investigated 30 specimens of oral leukoplakia and 35 dysplasia specimens adjacent to the tumor margin. We analyzed clinical variables including age, sex, degree of dysplasia, and smoking, clinical appearance of leukoplakia, number of lesions, location, size, clinical monitoring, malignant transformation and recurrence. For the immunohistochemical study, we used a noncommercial monoclonal antibody against human CA-IX MAb M75. We found greater CA-IX positivity in nonsmokers, erythroplakia and mottled leukoplakia, those located on the tongue, patients with multiple lesions, 2–4 cm leukoplakias and in recurrent cases, although differences were not statistically significant. All lesions in all samples without dysplasia were negative for CA-IX; however, for all other categories of dysplasia, the percentages of positivity and negativity varied. Regarding the diagnostic index values, we found a sensitivity of 32%, specificity of 100%, a positive predictive value of 100% and a negative predictive value of 13%. Leukoplakias appear mainly in females and potentially are malignant; more than 90% have some degree of dysplasia, and therefore require close clinical and histopathological monitoring. The CA-IX immunohistochemical marker may be useful for screening samples without dysplasia owing to its high specificity.     

The effectiveness of sodium lauryl sulphate as a shark repellent in a laboratory test situation

Swim-through chemical repellency tests, using sodium lauryl sulphate (SLS), cupric acetate, and rotenone, were conducted in a specially-designed roundabout tank on horn sharks, Heterodontus francisci , swell sharks, Cephaloscylliun ventriosum , and leopard sharks, Triakis semifasciata . Effective concentration thresholds (EC₅₀s) were calculated for two levels of response: (1) minimum noticeable and (2) strong. The SLS EC₅₀s were: horn shark 43.6 and 174.5 ppm; swell shark 95.1 and 160.0 ppm; and leopard shark inconclusive and 113.1 ppm. No response was discernible from cupric acetate. Rotenone evoked a weak response with an EC₅₀ of 5.7 ppm, but no strong response.
The ratio of the minimum noticeable EC₅₀: 24-hour lethal concentration (LC₅₀) indicated the relative repellency (compared to toxicity) of the chemicals. The ratio for SLS was 19:1 and for rotenone 57:1. SLS did not provoke a repellency response at a low enough concentration to function effectively as a classical, surrounding-cloud type, repellent. The range of potency of SLS, however, does allow it to be used as a directional repellent.     

Potential application of dot-immunobinding assay as a rapid diagnostic test in tuberculous meningitis

A simple dot-immunobinding assay (Dot-Iba) in nitrocellulose paper was developed for the detection of specific IgG antibody to Mycobacterium tuberculosis antigen 5 and mycobacterial antigen in cerebrospinal fluid of patients with tuberculous meningitis (TBM). The assay gave 77.1% sensitivity for the detection of IgG antibody to M. tuberculosis antigen 5 and 48.6% sensitivity for the detection of mycobacterial antigen in patients with TBM.     

Lesions of swine lymph nodes as a diagnostic test to determine mycobacterial infection.

Decisions as to the disposition of swine carcasses with lesions attributable to a mycobacterial infection are based upon a lesion criterion which is used as a diagnostic test by federal meat inspectors. Using this criterion, a federal meat inspector classified 58 of 100 pigs as "passed for cooking" and the other 42 pigs passed. Of the 58 pigs passed for cooking and the 42 pigs passed, mycobacterial isolations were made from the lymph nodes of 33 and 15 of the animals, respectively. The lesion criterion as a diagnostic test has the following attributes: 70% sensitive; 53% specific; 23% index of performance; 57% positive accuracy; and 67% negative accuracy.     

Drama as a valuable learning medium in early childhood

ABSTRACT

Theater arts encompass unique art forms comprising highly developed pedagogical applications apart from theater as performance. Specifically, the use of drama as a learning medium, referred to in the field as process drama, is most emphatically applicable to the education of young children. Young children actively gain skills in dialogue, collaboration, and creative problem solving, by collectively pretending, with teacher guidance, to be in an imaginative elsewhere—something most are well adept at from their own natural dramatic play. This article argues that ages 3–8 represent a critical time for children to benefit from process drama integrated into the curriculum and highlights the unique impact process drama can make when it is used to explore a particular problem, situation, or theme, referencing related national core arts. Documentation from well-established programs is presented, and recommendations for training drama teachers on how to work in early childhood and for early childhood teachers on how to integrate process drama into their curriculum are presented.     

Development of a diagnostic test system for detecting soluble staphylococcal antigens by an immunoenzyme method

ELISA is used for detecting the soluble staphylococcal antigen in patients with purulent septic infections. The optimum conditions for the assay have been established: the dose of staphylococcal gamma globulin for plate sensitization should be 5.0-10.0 micrograms/ml, the pH of the buffer solution 9.6-10.0, the time and temperature of incubation 18-20 hours at 4 degrees C or 5 hours at 37 degrees C. The possibility of using plates manufactured in the USSR has been shown. The sensitivity of the above diagnostic test system is 0.005 microgram/ml.